HIV/STI and alcohol/drug use during pregnancy are both associated with numerous negative consequences for the woman and the developing fetus. While pregnancy has been recognized as a window of opportunity in which to intervene, very few interventions exist that target both of these risks, and virtually none target both risks during pregnancy. The proposed research project will develop and assess an innovative, computer- delivered screening, brief intervention and referral to treatment (SBIRT) approach, the Health Check-up for Expectant Moms, which will address barriers in early identification and intervention with women at risk for HIV/STI primarily, integrating substance use given the well-supported relationship between these risks during pregnancy. This research addresses three priorities in line with NICHD's mission and Scientific Vision: (1) promoting research to develop interventions that influence a range of behaviors and health outcomes, (2) developing and enhancing personalized treatment that targets pregnant women, and (3) decreasing the potential for poor birth outcomes among women at greatest risk. The R21 will accomplish these objectives by developing and pilot testing a tailored, motivationally enhanced HIV/STI and alcohol/drug use risk reduction intervention that incorporates motivational interviewing and is consistent with the Information-Motivation- Behavior (IMB) model of HIV risk behavior, which posits that HIV/STI risk behavior is determined by an individual's information about HIV/STI transmission and prevention, motivation to reduce risk for HIV/STI infection, and mastery of behavioral skills necessary to reduce risk. The Health Check-up for Expectant Moms is a computer-delivered, brief intervention (one session plus a booster session) that is theory-driven and derived from empirical support. The R21 proposes two distinct phases to assess the Health Check-up for Expectant Moms in low-income pregnant women who are at risk for HIV/STI and alcohol/drug use. During the Development Phase, the research team will develop the software for the computer-delivered intervention and conduct informant interviews and an open trial with 10 participants. During the Pilot Study Phase, we will conduct a two-group, randomized controlled study with a sample of 50 pregnant women endorsing HIV/STI and alcohol/drug use risk. In the Revision Phase, we will conduct exit interviews, and revise the intervention, recruitment and research procedures in anticipation of preparing an R01 application to test the efficacy of the intervention in a larger clinical trial. Results of this program of research are expected to inform the development of integrated HIV/STI and alcohol/drug use interventions that are cost-effective, high-reaching and widely disseminable within prenatal care.